WHH News: The IUD Revisited

History Unforgotten. Unfortunately many of us remember the devastating health consequences that women suffered as a result of the Dalkon shield in the early 1970's. This faulty IUD caused health issues ranging from pelvic inflammatory disease and infertility to septic abortion and death. The device was poorly studied; one study conducted by the physician who designed the device was submitted to the FDA before it was approved for use and put on the market. It is still unclear why women who used the device had such an increased rate of infection. Some thought that it was because the sharp "fins" of the device embedded in the uterine wall or that the string broke down and served as a conduit for bacteria to enter the uterus. Multiple lawsuits ensued and AH Robbins who manufactured the Dalkon Shield filed for bankruptcy. It should be noted that in retrospect, some people believe that it was not the device but exposure to sexually transmitted diseases during the "free love" movement of the early 1970's that is responsible for the infections. After the Dalkon Shield was taken off the market it was many years before another IUD became available for use. The FDA approval process has changed since then insuring a much better safety profile of approved drugs and devices.

Dalkon Shield

What you should know about the IUD. There are two IUDs available in the US. The ParaGard T is a copper IUD and the Mirena is a progestin-releasing IUD. Both of these IUDs are about 99.9% effective against pregnancy. Once they are removed, fertility is quickly restored. They can be used by women of all ages and whether you have been pregnant or not. (The Mirena is not approved for use in women who have not had children though most providers feel it is safe in this group as well.) The ParaGard works by killing sperm and is effective for 10-12 years. The Mirena is thought to work by stopping the sperm from reaching the egg, stopping the egg from being released or thinning the lining of the uterus. The Mirena is effective for 5 years. The IUD is inserted by a trained provider in the office. The cost is $300-500.

Complications are rare but if they occur it is usually shortly after insertion. They include: infection (1/1000), perforation of the uterus (1/1000), expulsion or pregnancy (usually from expulsion). Women who are at risk for sexually transmitted infections should consider using another method.

Important benefits you may not know about. The Mirena can decrease the amount of menstrual blood by 70%. It can also significantly reduce menstrual cramping. 20% of women will not have a period after 1 year and 60% by 5 years. Women who have heavy bleeding or fibroids can avoid surgery in many circumstances.

Disadvantages to consider. Many women experience discomfort including spotting and cramping immediately after insertion. Bleeding can be irregular for about 3 months. Women who use the ParaGard can have heavier periods and more cramps. On the other hand, women who use the Mirena may stop getting periods and some women don't like this.

Bottom line: The IUD is a great option for women who want long term reversible contraception. The Mirena can be used to treat heavy bleeding and help many women avoid surgery.

For help deciding whether the IUD or other contraceptive methods are right for you go to the AHRP interactive website or give me a call, I would be happy to help you.